The purpose of the research was to describe the relationships between social support and role strain and preventative health behaviors. The sample consisted of 62 critical care nurses employed in three southwest acute care facilities. Subjects completed instruments measuring social support, role strain, and four preventative health care behaviors. Pearson correlations revealed significant positive relationships between social support and personal/household roles women perform and ways women handle stress. Additional significant negative relationships existed between marital/relationship roles women perform and leisure physical activities, a subset of preventative health behaviors. The parental roles, obligations, and responsibilities women perform were also significantly related with leisure physical activities. Conclusions drawn indicate that the critical care nurses did not perceive themselves susceptible to cardiovascular disease and therefore did not participate in preventative health care activities, regardless of perceived helpful social support and an absence of role strain.

The Diploma paper " The Health Care Providing System in Switzerland" describes the development, structure and typical aspects of health care providing system in Switzerland. The Diploma paper concentrates on identification of the key factors which helped Switzerland health care providing system to reach very high quality and also ensured large availability of the services. The work is divided into theoretical and practical part. Theoretical part describes Swiss Confederation and its health care providing system. The practical part offers the comparison with the system in Czech Republic. The finale part is devoted to the key factors which could be implemented into the Czech system and which would be helpful for its further development.

Neste estudo, minha proposta foi dirigir-me às pessoas portadoras de neoplasias em seu domicílio, buscando em um primeiro momento apreender o significado para os doentes de seu sendo-no-mundo com câncer, e a partir dessa compreensão, projetar novas possibilidades de cuidado a esses seres. A fenomenologia existencial de Martin Heidegger permitiu-me uma aproximação da existencialidade do doente, contemplando suas vivências com a doença. Para tal, realizei várias visitas aos sujeitos, antes e após a entrevista. A partir dos discursos e de minhas observações feitas durante as visitas, conduzi-me a uma compreensão das percepções dos pacientes sobre o estar-no-mundo com câncer. Da análise compreensiva emergiram duas categorias: A temporalidade do existir com câncer e o Ser-com-ooutro inautêntico no convívio com o câncer, as quais interpretei apropriando-me de algumas idéias de Martin Heidegger. E, finalmente, retomando o caminho percorrido, reflito sobre a assistência dispensada aos doentes e a importância de buscar novos caminhos para contemplar as reais necessidades de cuidados da pessoa com neoplasia. / In this study, my proposal was to direct myself to people who carry neoplasia at their dwellings, aiming, in the first instance, to understand the meaning of the being in world with cancer to the ill, and from this comprehension, to project new care possibilities to these beings. Martin Heidegger’s existential phenomenology allowed me to approximate myself to the ill person’s existentiality, contemplating his experience with the disease. For that, I accomplished several visits to individuals, before and after the interview. From the speeches and my observations fulfilled during the visits, I conducted myself to A comprehension of the ill perceptions of being in the world with cancer. From the comprehensive analysis, two categories emerged: The temporality of being with cancer and the inauthentic being-with the other in living together with cancer, which I interpreted adopting some Martin Heidegger’s ideas. Finally, recapturing the coursed path, I reflect on the exempt assistance to the ill and the importance of searching new to contemplate the real care necessities of the person with neoplasia.

Submitted by admin tede (tede@pucgoias.edu.br) on 2016-09-22T12:13:27Z No. of bitstreams: 1 Sirlei Alves.pdf: 1473806 bytes, checksum: 8caacd0bf58e851e6c5c99e7e3cf0552 (MD5) / Made available in DSpace on 2016-09-22T12:13:28Z (GMT). No. of bitstreams: 1 Sirlei Alves.pdf: 1473806 bytes, checksum: 8caacd0bf58e851e6c5c99e7e3cf0552 (MD5) Previous issue date: 2015-12-15 / Although Nursing adopts the notion of care in accordance with contemporary debates on mental health and although care is naturally associated to the feminine, instrumental practices which impact how Nursing performs this care are still prevailing. In this context, this dissertation intends to explore the senses which are attributed to care and the nexus with a gender perspective in the Nursing context from public domain documents. The dissertation is a qualitative research in Social Psychology anchored on socio-constructivist perspective with focus on real events socio-historically built as well as on language effects on social practices. Discursive practices and creation of meaning in daily life have been used as analysis methodology. The analyzed documents convey different meanings regarding care and indicate it is polissemic. Among the different conceptions, two positions from different origins of thoughts have excelled: a more holistic perspective, which accesses a comprehension of relational, integral, and human care, in which repertoires, meanings and notions associated to the language of Human Rights paradigm coexist. The other matrix, a more biological perspective, accesses a technicistic, hospitalocentric, and pathological care, which is influenced by biological sciences paradigm, demonstrating that this discursive field is marked by controversies. In relation to the intersection between care, Nursing, and gender, in one hand, Nursing has gained visibility as the profession of care in the health field; on the other hand, this care is often underestimated when it is historically associated to the feminine. Those discussions are also pertinent in an attempt to break off stigmas, bias, and prejudices which involve the insertion of the man in the Nursing profession. The care, intertwined to the historically built social relations established between men and women, positions the woman, the nurse, in a place of inferiority and subordination in relation to the man, the doctor. / Embora a enfermagem adote a noção de cuidado em consonância com os debates mais contemporâneos em saúde mental, e apesar de o cuidado ser naturalmente associado ao feminino, ainda prevalecem práticas instrumentais que impactam a forma como a enfermagem performa esse cuidado. Nesse contexto, pretende-se, nesta dissertação, explorar os sentidos atribuídos ao cuidado e aos nexos com a perspectiva de gênero no contexto da enfermagem a partir de documentos de domínio público. Trata-se de uma pesquisa qualitativa em Psicologia Social, ancorada na perspectiva socioconstrucionista com foco nos acontecimentos/realidade construídos sócio-historicamente, tal como nos efeitos da linguagem nas práticas sociais. Tem como metodologia de análise as práticas discursivas e a produção de sentidos no cotidiano. Os documentos analisados veiculam diferentes sentidos acerca do cuidado, indicando que ele é polissêmico. Dentre as distintas concepções sobressaíram duas posições, que vêm de matrizes distintas de pensamentos: uma perspectiva mais holística, que dá acesso a um entendimento do cuidado relacional/integral/humanizado, no qual coexistem repertórios, sentidos e noções associados à linguagem do paradigma dos Direitos Humanos. A outra matriz, mais biológica, dá acesso ao cuidado tecnicista/hospitalocêntrico/patológico, que recebe influência do paradigma das ciências biológicas, demonstrando que esse campo discursivo está sob disputa. Em relação à intersecção entre cuidado, enfermagem e gênero, se, por um lado, no campo da saúde, a enfermagem ganhou visibilidade como a profissão do cuidado, por outro esse cuidado é por vezes desvalorizado quando se associa, historicamente, ao feminino. Essas discussões são pertinentes, ainda, na tentativa de romper com os estigmas e preconceitos que envolvem a inserção do homem na profissão de enfermagem. O cuidado, entrelaçado às relações sociais historicamente construídas que se estabelecem entre homens e mulheres posiciona, a enfermagem, em um lugar de inferioridade e subalternidade.

Background/Aim: Historical evidences indicate that maternal health care by a skilled birth attendant is one of the key strategies for maternal survival. However, the rate of maternity care utilisation and reduction of maternal death is very low in Nigeria. This study was designed to investigate factors influencing access to emergency obstetric care with a view to guiding programmatic efforts targeted at overcoming these barriers and also contribute to health reforms in Nigeria. Hence, the need to understand factors influencing access to emergency obstetric care in Nigeria using the Socio-ecological Model (SEM) and Gender and Development (GAD) to identify associated factors operating at different levels. Methods: A mixed method was employed for this study. Data collection used questionnaires and in-depth interviews. Questionnaires were distributed to 330 respondents of which 318 of them were retrieved and qualitative in-depth interviews were conducted for 6 participants. Data collection were done using a sequential approach. The study was conducted in one of the tertiary health facilities in Nigeria from January-April, 2015, amongst mothers aged 15-45 years meeting the study inclusion criteria. Statistical Package for Social Sciences (SPSS) was used in analysing the quantitative data. Bivariate and logistic regressions were conducted for the quantitative data whilst a qualitative content analysis was done for the qualitative data. Results: The study established that education, income level, costs associated with seeking care, distance and time taken to travel were significantly associated with maternity healthcare services utilisation. Quality of service, staff attitude and women's autonomy showed consistent significant association with maternal health care utilisation. Conclusions: The study concludes that; costs of treatment, distance and time, income level, staff attitude and women's autonomy were critical in determining women utilisation of maternity care services. Recommendation: As an outcome of this research, best practice framework has been developed. The framework presents a coherent and systematic approach for achieving sustainable MH by providing a roadmap for instituting measures at the policy, health facility, community and at the individual levels, taking into account factors that are likely to promote or impede the achievement of sustainable MH.

The Healthcare Quality Strategy for NHS Scotland, relates its overall vision of healthcare quality to six dimensions of care as: Safe, Efficient, Effective, Equitable, Timely and Patient Centred. Patient Centred Care also underpins many subsequent policies such as the management of Long Term Conditions (Scottish Government, 2008) and the Chief Medical Officers Realistic Medicine report (Barlow, et al., 2015) Leadership styles and associated policies and procedures are often assumed to inhibit or encourage the delivery of quality Patient Centred Care and the NHS invests millions of pounds per year in Leadership training. At a clinical team and management level there are behaviours and initiatives that can arguably have positive and negative impacts on the ability of individual practitioners to provide quality Patient Centred Care. However there have been no attempts to empirically test the association between (good) Leadership and quality Patient Centred Care. Without any evidence of such a relationship, NHS investment of substantial resources may be misguided. Additionally, much of the focus of research in both Leadership and Patient Centred Care has focused on medical practitioners and nurses. There is little research that focuses on the impact of allied health professionals' (a term describing 12 differing health care professional groups representing over 130,000 clinicians throughout the United Kingdom) practice on the quality of person centred care and how this is affected by Leadership structures and styles. This study aimed to explore whether there is a direct or indirect link between (transformational) Leadership and achieving the delivery of high quality Patient Centred Care (PCC) in allied health professional (AHP) practice. Aim The aim of this thesis was to explore whether it was possible to empirically demonstrate a relationship between Leadership (good or bad) and Patient Centred Care, and to do this in relation to Allied Health Professional practice. Research questions I. Is there a relationship between Transformational Leadership and Patient Centred Care in AHP practice? II. How do AHP’s conceptualise Leadership and its impact on their ability to deliver PCC? III. Do local contexts influence the ability of leaders to support Patient Centred Care? Study one Study one was designed to answer research question one: exploring the relationship between transformational Leadership and Patient Centred Care using survey design. Two groups of Allied Health Professionals were selected to take part in the study: Podiatrists and Dieticians. Clinical team leaders from across 12 Podiatry teams and 12 Dietetic teams completed a survey composed of measures of transformational Leadership and self-monitoring. Clinicians from these teams were also be asked to complete questionnaires on their perception of their clinical leaders’ transformational Leadership skills. This allowed comparison of self-assessed Leadership and team assessed Leadership. Clinicians were also asked to collect patient experience measures from 30 of their patients. Study Two Study Two was designed to answer research questions 2 and 3: how do AHPs conceptualise Leadership and how do they view the link between Leadership and their ability to deliver Patient Centred Care; and how might local context impact on professional Leadership and therefore its potential to enable or inhibit Patient Centred Care. In depth interviews were conducted with clinicians and clinical team leaders to explore the barriers and facilitators to effective Leadership, teamwork and the provision of quality care. Interviews were conducted with 21 Podiatrists and 12 Dieticians and analysed using a framework analysis approach. Results I. Is there a relationship between Patient Centred Care and transformational Leadership in AHP practice? The theory that there is a link between transformational Leadership and Patient Centred Care was confirmed. A significant relationship was discovered for the dietetics group linking Transformational Leadership with patient centred quality of care measures. There was also a relationship in the podiatry group that was suggestive of a relationship. II. How do AHP’s conceptualise Leadership and its impact on their ability to deliver PCC? AHP’s in both groups had broadly similar conceptualisations of Leadership and both groups played down the role of Leadership in the delivery of Patient Centred Care. A far more salient factor in achieving the delivery of high quality Patient Centred Care for the AHP’s interviewed was professional autonomy. III. Do local contexts influence the ability of leaders to support Patient Centred Care? A number of contextual issues related to both Patient Centred Care and Leadership were identified from the qualitative analysis. These were centred on systemic factors, relating to management and bureaucracy, and individual factors, such as relationships within teams. In Podiatry a major shift in the context of care was ongoing during the study, namely a greater emphasis on encouraging patients to self-care. This affected the relationships between patients and Podiatrists, and Podiatrists and managers, in a way that Podiatrists felt it negatively impacted on their ability to provide quality Patient Centred Care. Conclusion A weak relationship was observed between Transformational Leadership styles and the delivery of Patient Centred Care in two Allied Health Professional groups. Professional autonomy was identified as being more likely to facilitate delivery of person centred care. Organisational issues and intervening policy directives can impact on the delivery of Patient Centred Care, regardless of Leadership. Recommendations Further work exploring the link between Leadership and Patient Centred Care is required. The concept of professional autonomy should be fostered within Leadership programs to enhance delivery of Patient Centred Care. The impact of individual policies, such as moves towards more self-care, on quality criteria need to be more fully considered. Whilst such policies may make care more efficient, there may be negative consequences for other quality care criteria, such as Patient Centred Care.

The health industry in Canada, as well as in other industrial countries, has been in the process of reform for many years. While such reform has been attributed to fiscal necessity due to increased health costs, the underlying causes are far more complex. Demographic changes, new technologies, expanded health care procedures and medications, increased demand and the globalization of health services have all contributed to the change and complexity of the industry. Health reform varies from country to country. In Canada, with a publicly funded health industry, the main reform method has been regionalization. This decentralized reform method arranges health services under a regional corporate management structure. The primary objective of this study was to assess the effects of health reform on the educational development of health-care managers in British Columbia, a western province of Canada. The study had a two-fold approach; to ascertain how health reform had changed the skill needs of health-care managers, and whether e-learning could benefit health management education. The key research questions that guided the study were: How might recent changes in the health industry have affected the learning needs and priorities of health-care managers? What factors might hinder attempts to meet any learning needs and priorities of health-care managers? and What benefits might e-learning provide in overcoming hindrances to effective health management education? / A combination of quantitative (survey closed questions) and qualitative (survey open-ended questions, interviews and stakeholder feedback) methods was employed in this study. Overall, this study is described as productive social theory research, in that it addressed a recognized change in learning needs for health-care managers following a period of health reform, a socially significant phenomenon in the health industry. Relying on such tools as a survey, interviews, and stakeholder discussions, data was collected from over five hundred health-care managers. The data collected in this study provided valuable insight into the paradigm shift occurring in the educational needs of these managers. The study found that health reform had expanded the management responsibilities of healthcare managers and increased the complexity of service delivery. Restructuring of the health industry decreased the number of managers, support systems, and career opportunities for managers and increased the manager’s workload, communication problems and the need for new knowledge and skills. In addressing the learning needs of health-care managers, the study found there were limitations in health management educational opportunities available to health-care managers. The findings also show that current health management education was focused on senior managers leaving the majority of industry leaders with limited learning opportunities to upgrade their knowledge and skills at a time of great organizational change. / In addition, a classroom format dominated the learning delivery options for many managers. A list of fourteen management skills was used in the survey instrument to ascertain what new skills were needed by health-care managers following thirteen years of health reform. The findings show that of the fourteen skills, twenty-nine percent of health-care managers had no training and fifty-seven percent received their training through in-service, workshops and seminars. Irrespective of gender, age, working location and education the data showed that healthcare managers were mainly receiving training in change and complexity and people skills with less training occurring in planning and finances. Using the same fourteen skills, health-care managers priorized their immediate learning needs, listing the top three, as: evidence-based management, change and complexity and financial analysis. While evidence-based management and financial analysis could be attributed to the introduction of a corporate management structure in the health industry, change and complexity was an anomaly as managers were already receiving training in this skill. Health industry stakeholders believed this anomaly was due to continued uncertainties with ongoing health reform and/or a need for increased social interaction during a time of organizational change. In addressing the many learning needs of health-care managers a new health management education strategy was proposed for the province which included the need for an e-learning strategy. / The e-learning approach being proposed in this study is an integration of skill training and knowledge sharing directly blended into the workflow of the managers, using a variety of learning technologies. To support this idea, the study found that the majority of health-care managers were not only familiar with e-learning, they also felt they had the computer and Internet skills for more learning delivered in this manner. While a strong need for face-to-face learning still remained, a blended e-learning strategy was proposed for skill training, one that would accommodate the learning needs of managers in rural and remote areas of the province. Knowledge sharing technologies were also proposed to improve the flow of information and learning in small units to both newcomers and experts in the industry. Since this would be a new strategy for the province, attention to quality and costs were identified as essential in the planning. The study found that after years of health reform a new health management educational strategy was needed for the health industry of British Columbia, one that would incorporate a number of learning technologies. Such a change in educational direction is needed if the health industry wishes to provide their leaders with a responsive learning environment to adapt to ongoing organizational change.

Thesis (Ph.D.)--McMaster University, 2006. / Supervisor: Susan J. Elliott. Includes bibliographical references (leaves 166-171).

Syftet: Ur ett patientperspektiv beskriva faktorer som påverkar kommunikationen mellan sjuksköterska och patient från olika kulturer. Metod: Litteraturstudie där fjorton artiklar från olika länder har analyserats.  I studierna har patienter och tolkar intervjuats om sina upplevelser och erfarenheter av vården. Resultat: Studien visade hur patienter med olika kulturell bakgrund i olika länder upplevde olika problem vid vårdvistelse på grund av att inte tala samma språk som vårdgivaren. Språkbarriärer bidrar till en ofullständig kommunikation. Användande av tolk, både professionell och icke-professionell, det vill säga vän eller familjmedlem som tolk, kan skapa problem. Andra faktorer som bidrog till att försvåra kommunikationen var olikheter i kultur och kulturella begrepp om hälsa och sjukdom. Slutsats: Kommunikationsbarriärer mellan sjuksköterska och invandrarpatienter upplevdes som ett stort hinder i samband med en vårdvistelse. Språkbarriären hindrade att förmedla hälsoinformation. Patienter med en annan kultur än svensk kände sig missnöjda och upplevde missuppfattningar, detta ledde till en försämrad omvårdnadskvalité och patienterna undvek att ta kontakt med sjukvården. Att inte kunna kommunicera kunde även leda till depression för en invandrarpatient. En professionell tolk bör anlitas i första hand. Det är även viktigt att sjuksköterskor har kulturell kompetens och nödvändig kunskap för att kunna möta patienter från andra kulturer. / Aim:   The purpose of this literature study was to describe factors that affect communication between nurses and patients from different cultures from a patient perspective. Method:  Fourteen studies from different countries were analyzed where researchers interviewed patients and some interpreter and presented their experiences in care. Findings: The study demonstrated how patients with different cultural backgrounds in different countries experienced different problems in care due to not speak the same language as the caregiver. Lack of language barrier - communications, both professional interpreters and family members as interpreters may create problems, culture and cultural concepts of health and illness. Conclusion:  Ccommunications barriers between nurses and immigrant patients were seen as a major obstacle in the context of a nursing residence and if possible, hire a professional interpreter. The language barrier prevented to convey health information.  Patients with a different culture felt dissatisfied and experienced misconceptions; this led to the deterioration of nursing quality and patient avoided contact with medical services. Not being able to communicate could also lead to depression for immigrant patients. It is important that nurses have cultural competence and skills necessary to meet patients from other cultures.

Thesis--University of California, San Francisco. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 255-260).